3,000 dead and Congo’s Ebola Outbreak still hasn’t peaked

CONGO HAS CROSSED A TERRIBLE LINE

The Democratic Republic of Congo has recorded more than 3,000 deaths from Ebola in an outbreak that is still showing little sign of slowing down.

On September 2, the World Health Organization confirmed that the epidemic had passed 6,000 reported cases and reached 3,000 deaths. WHO Director General Tedros Adhanom Ghebreyesus described it as the fastest moving Ebola outbreak the organisation has seen and the second largest Ebola epidemic ever recorded anywhere in the world. 

For Congo, however, this is already the worst Ebola outbreak in the country’s history.

That is an important distinction.

The country has lived with Ebola for decades and has accumulated considerable experience in dealing with the disease. Congo has trained health workers, built laboratory capacity, developed surveillance systems and participated in some of the world’s most important Ebola vaccine and treatment programmes.

Yet this outbreak is still outrunning the response.

The obvious question is why.

THIS IS NOT THE EBOLA OUTBREAK CONGO KNOWS BEST

One reason is the virus itself.

The current outbreak is caused by the Bundibugyo species of Ebola virus, rather than the Zaire species that caused several previous outbreaks in Congo.

That matters because the vaccines and treatments that transformed the response to Zaire Ebola do not offer the same proven protection against Bundibugyo Ebola.

There is currently no approved vaccine specifically for the Bundibugyo species and no approved antiviral treatment for it. Trials are under way, while some existing Ebola vaccines are being used among frontline workers as scientists gather more evidence. 

This has left health authorities fighting a fast spreading epidemic without some of the tools that helped bring previous outbreaks under control.

But the virus is only part of the problem.

THE OUTBREAK IS SPREADING THROUGH A REGION ALREADY IN CRISIS

Much of the epidemic is concentrated in eastern Congo, where conflict, displacement and weak public infrastructure have already placed enormous pressure on the health system.

Millions of people have been displaced by fighting.

Communities move regularly between villages, mining areas, towns and displacement camps.

Some areas remain difficult for health workers to reach.

In other places, insecurity has disrupted contact tracing and treatment.

This is particularly dangerous with Ebola because controlling the disease depends heavily on finding infected people quickly, identifying everyone they have been in contact with and isolating new cases before another chain of transmission begins.

That system is not working well enough.

Associated Press reported that only about 19 per cent of an estimated 97,600 contacts had been traced, while many infections were being detected outside previously known transmission chains. Africa CDC has warned that the outbreak has not yet reached its peak. 

If health authorities do not know where most infections are coming from, they are effectively following the virus rather than getting ahead of it.

PEOPLE ARE ALSO LOSING TRUST

There is another difficulty which cannot be solved by medicine alone.

Public trust has become a major part of the crisis.

Some communities have resisted official burial procedures. Ebola response teams have been attacked. Treatment facilities have faced hostility and some families continue to struggle with restrictions on traditional funeral practices.

These tensions have appeared in previous Ebola outbreaks, but they are particularly dangerous when transmission is already widespread.

Ebola spreads through direct contact with the bodily fluids of an infected person, including after death. Safe burial is therefore one of the most important measures used to stop transmission.

But telling a family that they cannot bury a loved one according to their traditions requires trust in the health authorities.

When that trust is absent, public health becomes much harder.

Health workers themselves are also under tremendous pressure. Treatment centres in some parts of Ituri and North Kivu are overwhelmed, while health workers have complained about working conditions and delayed support. 

CONGO IS NOW USING MOBILE PHONES TO FOLLOW THE VIRUS

The scale of the challenge is forcing authorities to try new methods.

Health officials are now using anonymised mobile phone data to understand how people move between affected communities and where the virus could spread next.

The technology analyses signals generated when mobile phones connect to different telecommunications towers. That allows epidemiologists to identify major travel routes and places that may be at higher risk before large numbers of cases appear.

The system has already helped officials identify important movement patterns between places including Bunia, Mongbwalu and Rwampara, and has raised concern about connections to larger transport centres such as Kisangani. 

It is an innovative response to a difficult problem.

But technology alone cannot compensate for weak surveillance on the ground.

A mobile phone can tell health authorities where populations are moving.

It cannot replace nurses, laboratories, isolation beds, ambulances, community health workers and trusted local leaders.

THE REST OF AFRICA CANNOT TREAT THIS AS CONGO’S PROBLEM

Ebola does not respect provincial or national borders.

The current outbreak has already demonstrated how quickly disease can move through populations connected by trade, mining, family relationships and transport routes.

WHO continues to regard the risk of wider spread as serious, particularly because affected areas sit close to international borders and major population routes.

That makes this a continental health issue.

African governments have spent years strengthening disease surveillance after Ebola, Covid 19 and mpox. The current crisis in Congo is another test of whether those systems are strong enough to detect and contain outbreaks before they become regional emergencies.

It is also a test of international attention.

When Ebola reached West Africa between 2014 and 2016, the world eventually mobilised enormous resources. More than 11,000 people died before that epidemic ended.

Congo has not reached that level.

But 3,000 deaths should be enough to command the world’s attention.

WHO says approximately $1.3 billion is needed to scale up the response, expand treatment capacity and strengthen surveillance. 

The danger is waiting until the numbers become even more frightening before the required resources arrive.

THE OUTBREAK HAS NOT YET PEAKED

There is a temptation with Ebola to believe that Africa already knows how to defeat it.

In many ways, that is true.

Scientists understand the virus better than they did a decade ago. Health workers have more experience. Laboratories are faster. Surveillance systems are stronger. Vaccines and treatments have changed what is possible against some Ebola species.

But epidemics do not happen in laboratories.

They happen in communities.

They happen in places affected by war, poverty, mistrust and weak infrastructure.

That is what Congo is confronting today.

More than 3,000 people are dead.

Thousands more have been infected.

The virus has moved across several provinces.

And health officials say the epidemic has still not reached its peak.

Africa has learnt a great deal about Ebola.

The question now is whether those lessons can be turned into enough people, money, trust and medical capacity to stop this outbreak before another thousand families lose someone.